Abstract
Isotretinoin (ISO) is a drug which is used for the treatment of severe and refractory acne vulgaris (AV), over the last few decades. The drug has various musculoskeletal side effects. The aim of this study was to investigate relationship between serum 25 hydroxy (OH) vitamin D levels and the ISO-induced musculoskeletal side effects in patients with AV. We included 87 patients receiving ISO and had musculoskeletal symptoms as adverse effect (AE) group. Another 90 patients receiving ISO for AV and had any musculoskeletal complaints were recruited as control (C) group. Locomotor system examination of the patients was performed by the same clinician. Serum 25 OH vitamin D levels of the all participants were measured. Patients in the AE group were divided into three subgroups by serum 25 OH vitamin D levels. Patients with serum 25 OH vitamin D level lower than 10 ng/ml was classified as Group I, the ones between 10–20 ng/ml as Group II and those higher than 20 ng/ml were classified as Group III. AE and C groups were similar in terms of age and sex (p > 0.05). There was no statistically significant difference in the mean serum vitamin D levels between two groups (p = 0.17). Also, there was no significant difference in number of arthralgia (p = 0.30), myalgia (p = 0.29), low back pain (p = 0.10) and sacroiliitis (p = 0.17) between three subgroups in AE group. In addition, we found no statistically significant correlation between the serum vitamin D levels and age, cumulative dose of ISO, arthralgia, myalgia and sacroiliitis parameters in AE group (p > 0.05). Serum 25 OH vitamin D levels between the AE and C groups were similar. We also found that no significant difference in musculoskeletal adverse events between AE subgroups. Therefore, it can be concluded that vitamin D deficiency has no effect on the musculoskeletal adverse events in patients receiving ISO.
Highlights
Isotretinoin (ISO) is 13-cis-retinoic acid, a synthetic vitamin A analogue and the most effective drug in treatment of recalcitrant acne vulgaris (AV) for more than three decades[1,2,3,4,5]
The serum 25 OH vitamin D levels were measured by radioimmunoassay for all the participants. These results showed that patients in adverse effect (AE) group were divided into three subgroups according to the serum 25 OH vitamin D levels
We evaluated 87 patients with musculoskeletal symptoms related with ISO and 90 patients without any musculoskeletal symptoms in terms of serum 25 OH vitamin D level
Summary
Isotretinoin (ISO) is 13-cis-retinoic acid, a synthetic vitamin A analogue and the most effective drug in treatment of recalcitrant AV for more than three decades[1,2,3,4,5]. ISO has a wide spectrum of adverse effects on multiorgan systems, including reproductive, cutaneous, ocular, neurological, musculoskeletal, and hepatic. It may cause teratogenicity, hepatitis, dryness of skin, psychological effects and cerebral ischemia. The association ISO and vitamin D levels was evaluated by several studies in the literature[17,18,19]. The relationship between ISO-induced musculoskeletal side effects in AV patients and serum vitamin D levels has not been investigated until now. To the best our knowledge, this is the first study to evaluate relationship between the serum vitamin D levels and ISO-induced musculoskeletal adverse effects
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